Radiation Team Sent to Brazil Saves Two With a New Drug

By HAROLD M. SCHMECK Jr.

Published: November 2, 1987

Members of the international medical team that treated victims of the Chernobyl disaster have spent more than two weeks in Brazil where they used an experimental technique to save two of the most gravely injured victims of a radiation accident.

The team, which faced difficulties they had not previously encountered, was led by Dr. Robert Peter Gale of the University of California at Los Angeles.

Unlike those injured by radiation when the Chernobyl nuclear plant in the Soviet Union exploded and burned in the spring of 1986, many of the Brazilian patients themselves became dangerously radioactive when they came in contact with powdered cesium-137, a highly radioactive substance contained in a piece of medical equipment dismantled for scrap.

''This was something that most of us had not really thought much about having to deal with,'' Dr. Gale said Friday. ''It was a very unusual situation.'' Six patients were given the experimental treatment, a substance that stimulates growth of certain vital blood cells. Two recovered and four died.

The accident occurred late in September when a piece of radiation equipment that two young scavengers had taken from an abandoned clinic in Goiania in central Brazil was dismantled in a junkyard. Powder Is Taken Home

In the junkyard, people were fascinated by the blue glow the compacted cesium emitted. Thinking that anything so mysterious and beautiful must have magical powers, they took particles of it home. Some ate the powder.

The authorities learned of the accident only when people began to fall ill, many from the destruction of blood cells caused by radiation damage to bone marrow. A 6-year-old girl was among the four who died.

''The little girl was so radioactive that she posed a substantial health risk to the staff,'' Dr. Gale said. ''Dealing with her blood or urine became a major problem.''

Staff members were monitored to make sure they did not receive excessive doses of radiation and they were instructed to spend only a limited time with the radioactive patient.

But in practice, Dr. Gale said, ''this little girl was really sick and no one was counting the minutes.''

The patients had to be kept in a completely isolated special facility. Everything that came out of the unit had to be handled as radioactive waste.

Samples of the patients' blood and urine were radioactive, so they could not be sent out to a central laboratory. Instead, a special laboratory was set up, separate from other facilities.

One of the deadly health hazards of excessive radiation is destruction of the bone marrow, the tissue that gives rise to blood cells that are vital to all the body's functions, including defense against germs.

Some heavily irradiated survivors of Chernobyl were given bone marrow transplants, but the procedure is risky and it is used in radiation cases only if there appears to be no hope that the patient's own marrow will revive.

The cases in Brazil were not in this category, Dr. Gale said. Furthermore, the presence of radioactive material in their bodies would have damaged the transplanted marrow, reducing its chance for survival. Six Given New Treatment

Radioactive cesium produces dangerously penetrating gamma radiation. Although it takes 30 years for half of it to decay harmlessly, the material is gradually excreted from the body, so that most of it is gone after a year. Until then, however, it continues to damage the tissues.

Six of the most seriously ill patients were treated with a substance made naturally by the human body that stimulates growth of certain vital blood cells. Through genetic engineering methods it has been manufactured for use as an experimental drug.

The substance is granulocyte-macrophage colony-stimulating factor, known to specialists as GM-CSF. It was developed for medical use by Immunex, an American biotechnology company and licensed to Behring, a West German pharmaceutical company for manufacture.

Coincidentally, Dr. Gale was attending a medical conference in West Germany when the invitation came from Brazil to go there to treat radiation victims. The day before he left, he had heard a report by a doctor from Mainz on the medical use of GM-CSF. On his way to the airport, Dr. Gale stopped in Mainz to pick up a supply. Thereafter, Behring sent additional supplies almost daily, at no cost to recipients.

''I'm sure we used several million dollars worth of GM-CSF,'' Dr. Gale said.

Administering the drug is exacting. A little more than a tenth of a pint must be given in a carefully regulated continuous infusion over a period of 24 hours. The infusion must go directly into the vena cava, the great vessel through which oxygen-depleted blood returns to the heart. All this takes special equipment, much of which had to be sent from the United States.

Dr. Armand Hammer, the American philanthropist who played a major role in the international team's work after Chernobyl, arranged for the shipments and for supplies of sophisticated American antibiotic drugs that were vital to treatment of the infections suffered by the heavily irradiated Brazilians. Concept 'Taking Hold'

Dr. Gale said that in addition to the two patients treated with GM-CSF who recovered, three of the others showed that the treatment was actually stimulating their blood cell production. He said it would take a while to analyze data from the use of the procedure in Brazil. But he said it appeared that the treatment would hasten recovery of patients whose bone marrow is damaged but not totally destroyed by severe exposure to radiation.

Over all, Dr. Gale said, he was particularly impressed by the fact that the international team functioned effectively and was better organized than at the time of Chernobyl. Members of the team keep in touch with each other and Dr. Gale was able to reach them and arrange for them to go to Brazil.

The group that went to Brazil included a Soviet radiation biologist as well as two medical scientists from U.C.L.A. Others in this country coordinated the provision of supplies.

''It seems that this concept of a nuclear accident response team is actually taking hold,'' Dr. Gale said.

Photo of Dr. Robert Peter Gale with patient who received experimental drug (NYT) (Pg. 14)